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Switch from Pap smears set to cut GP repeat workload tenfold

GP workload from conducting repeat smear tests will be cut almost tenfold in a radical overhaul of the cervical cancer screening programme in England and Wales.

The Government has announced a switch from Pap smears to liquid-based cytology (LBC) will be rolled out over the next five years. The change should cut the proportion of women needing a repeat smear from 9 per cent to as little as 1 per cent, according to results from the pilot sites.

The National Cancer Screening Committee has also ruled that new age-linked screening intervals should replace the current 'hotchpotch' of local policies (see above).

Screening will be abandoned in under-25s after Government-commissioned research found 99 per cent of abnormal smears in that age group are false positives.

Leaders of the LBC pilot trials said every GP and practice nurse conducting smear tests would need a half day's training in the new technique.

The switch to LBC will cost £10 million, with the Government pumping in £7.2 million as a kick-start.

The introduction of LBC should cut backlogs in laboratory cytology services. Three-quarters of women currently wait more than four weeks for their smear test result and 7 per cent wait over 12 weeks. The average wait fell from eight to two weeks after the switch to LBC when the technique was piloted in Bristol.

Avon LMC chair Dr Phil McCarthy said GPs involved in the Bristol pilot supported the switch to LBC.

But he warned the new screening intervals meant many GPs, including those in his area, would see a 'big increase' in workload as they switched from five-yearly tests.

Around 45 per cent of women in England and Wales are currently screened less than every three years and 5 per cent are not screened within the five-year limit.

Under the new contract, cervical cytology is an additional service that also attracts up to 22 quality points.

The switch from Pap smears to LBC has already begun in Scotland. No decision has been taken in Northern Ireland.

New cervical cytology screening intervals

Age Frequency of smear test

Under 25 Do not screen

25-49 Every three years

50-64 Every five years

Over 65 No routine screening

Liquid-based cytology

 · GP or nurse collects sample from neck of cervix using brush-like plastic spatula

 · Spatula head broken off into vial of preservative

 · Vial sent to laboratory and centrifuged to remove obscuring material

 · Random sample of cells examined

 · Remaining fluid can be used for other tests

(eg HPV, chlamydia)

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